Disposal of dead bodies in emergency conditions
WHO/WEDC technical notes on WASH in emergencies
Step 1: Body recovery
Bodies should be recovered as quickly as possible, but without interrupting other activities aimed at helping survivors. Rapid recovery aids identification and reduces the psychological effects on survivors. Bodies should be placed in body bags. If these are not available, use plastic sheets, shrouds, or other locally-available materials. Separate body parts such as arms or legs should be treated as individual bodies. Do not try to match severed parts at the disaster site.
Personal belongings should be kept with the body. They will aid identification and may have legal and psychological implications for survivors.
Keep details of the place and date when the body was found, using a form similar to that shown in Box 8.1.
Give the body a unique reference number, copy it on to waterproof labels and attach these to both the body and its container. Labels should not be removed until the body has been collected by relatives.
Temporary storage of dead bodies
In warm climates, a body will begin to decompose within 12 to 48 hours. If possible, keep the body under refrigeration between 2°C and 4°C, at least until it has been formally identified. A refrigerated transport container used by shipping companies can store up to 50 bodies.
Where this is not possible, temporary burial is the next-best option. Dig a trench 1.5m deep, at least 200m from any water source and at least 2m above the water table. Lay the bodies in a single layer leaving 0.4m between each (Figure 8.5). Clearly mark the position of each body at ground level with its unique identification number.
Identification and release
As bodies decompose quickly, especially in warm climates, they should be identified as soon after recovery as possible. Make a photographic record of the body (Box 8.2). Clean the body sufficiently to allow key features to be visible and make sure the identifying label is visible in each photograph. Leave clothing on the body and store it with all belongings. Complete an identification form such as that in Annex 1 of Morgan (2006).
Identifying a loved one from amongst a mass of dead bodies is extremely distressing. Try to minimize emotional stress. First, use good quality photographs as the preliminary phase of the identification process. Visual identification is the simplest method, but not always the most reliable, particularly if the body is disfigured or has begun to decompose. Always cross-check identification by using personal belongings or special identifying marks.
Bodies that are severely disfigured or have decomposed may have to be identified by scientific methods such as DNA testing or referral to dental records.
Bodies should only be released to relatives once a formal identification has been made. A formal handover document (such as a death certificate) should be provided. Keep a record of the people collecting the bodies of their relatives.
Long-term storage and disposal
Only in rare cases can the mass disposal of unidentified dead bodies be justified.
It is a basic human right for a deceased person to be identified, issued with a death certificate and disposed of in accordance with local customs. Failure to do so causes distress to relatives and can lead to long-term mental health problems.
All identified bodies should be released to relatives for final disposal.
Long-term storage will be required for bodies that are unclaimed. Burial is the preferred method as other methods destroy the evidence for future identification.
Bodies should be buried 1.5 to 3.0m deep in marked graves and following local customs and traditions. Communal graves should only be used in the case of an extreme disaster.
The minimum distance from water sources is shown in Table 8.1.
Minimum distances to water sources
|Number of bodies||Distance from water source|
|4 or less||200m|
|5 to 60||250m|
|60 or more||350m|
|120 bodies per 100m2||350m|
|Note: The bottom of grave should be at least 2.0m above the groundwater table.|
Remember, a body must be buried with its unique reference number attached to it and to the container.
Support for relatives
The dead and bereaved should be respected at all times. It is a priority for affected families to know the fate of their loved ones. A sympathetic and caring approach is necessary. Take note of cultural and religious needs, but give honest and accurate information about the circumstances of death, even if this appears to cause further grief.
Measures to reduce the risk of infection from dead bodies
|Disease||Use PPE (1)||Use body bag||Allow viewing||Allow embalming|
|Viral haemorrhagic fever (3)||Hantavirus||No||No||Yes||Yes|
|Ebola / Marburg||Yes||Yes||Yes||No|
|Crimean-Congo Haemorrhagic fever||Yes||Yes||Yes||Yes (with full PPE)|
|Lassa fever / arena viruses||Yes||Yes||Yes||Yes (with full PPE)|
|Rift Valley fever||No||No||Yes||Yes (with full PPE)|
|Influenza||Yes||No||Yes (with mask / goggles)||Yes|
|(1) Personal Protective Equipment such as goggles/visor/face shield, gloves, medical mask, boots, coverall/gown, apron|
|(2) Disinfect the body e.g. with 2% chlorine solution|
|(1) Blood-borne transmission: tissues, vomit, blood|